| NPI | 1407302334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801096491) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801096491) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2020-11-12 |